How often should I perform a self-breast examination (SBE)?

Breast Self-Examination Recommendations

It is acceptable for women to choose not to do breast self-examination (BSE) or to do BSE regularly (monthly) or irregularly, as the American Cancer Society no longer recommends mandatory monthly BSE. 1

Current Guidelines for Breast Self-Examination

• Beginning in their early 20s, women should be informed about the benefits and limitations of breast self-examination 1
• The importance of promptly reporting any new breast symptoms to a healthcare professional should be emphasized, regardless of whether a woman performs regular BSE 1
• Women who choose to perform BSE should receive proper instruction and have their technique reviewed during periodic health examinations 1, 2
• BSE should not be recommended as a mandatory screening method for women in the general population 3

Evolution of BSE Recommendations

• The American Cancer Society previously recommended monthly BSE beginning at age 20 1, but has since revised this position
• Current guidelines recognize that BSE has not been shown to reduce breast cancer mortality and may increase the rate of biopsies performed 1
• The U.S. Preventive Services Task Force found insufficient evidence to recommend for or against BSE 1

Proper BSE Technique and Timing

• For women who choose to perform BSE, the examination should include both inspection and palpation to detect any changes in the breast 4
• Women with regular menstruation who choose to perform monthly BSE should do so on a particular day, preferably the fifth to seventh day after menstruation begins 4
• BSE technique should be reviewed by healthcare professionals during regular clinical breast examinations 1, 2

Benefits and Limitations of BSE

Benefits:

• BSE is a self-generated, non-invasive method of breast cancer detection 5
• Some studies have associated more frequent BSE performance with more favorable clinical stage and fewer axillary lymph node metastases 6
• BSE promotes breast awareness and self-efficacy in women's health management 5

Limitations:

• Evidence from randomized trials has not shown that regular BSE reduces breast cancer-specific or all-cause mortality 1
• BSE may increase the number of biopsies performed for benign conditions 1
• Lack of knowledge/skill on proper BSE technique is a key barrier to regular practice 5

Comprehensive Breast Cancer Screening Approach

• Clinical breast examination (CBE) should be performed every 3 years for women in their 20s and 30s, and annually for women 40 and older 1, 2
• Annual mammography should begin at age 40 1, 7
• Women should be educated about breast cancer risk factors and the importance of recognizing breast changes 2

Common Pitfalls to Avoid

• Failing to provide adequate education about the importance of recognizing and promptly reporting new breast symptoms 2
• Overlooking family history that might indicate need for earlier or more intensive screening 2
• Assuming that BSE alone is sufficient for breast cancer detection without other recommended screening methods 1

BSE remains an option for breast awareness, but should be presented as a choice rather than an obligation, with emphasis on prompt reporting of any breast changes regardless of whether formal BSE is performed.